On Ob/Gyn

Those of you who know me know that I really do not enjoy the field of ob/gyn. It's hard to say exactly why. And honestly, I don't even know if I can pinpoint the exact reason(s). It's like asking someone why don't you like the color orange? Or why do you prefer your sandwiches cut into rectangles as opposed to triangles? I guess I could come up with some reasons. But I'm not here to complain about the field. I'll give a fairly objective view of my rotation.

I did my ob/gyn in Buffalo, NY. It was intense. A week of labor and delivery on days, a 24 hour weekend call, then straight into a week of labor and delivery nights, then a week of gyn surgery on days, then a week in the free clinic. You show up around 6am and round before signout. You signout then begin your day doing labor checks, delivering babies, and C sections. Around 530pm you do signout to the night team. Lather (extra soap), rinse, repeat. There's something about dealing with all the fluid and gunk with deliveries that's just not my thing. I can drain abscesses, do rectal exams, suck an empyema out of a lung, and touch fungus infected feet, but these unearthly delights coming out of the vag is just not me. Ugh. You can kind of do as much or as little as you want. But of course, I always try to do more than less because honestly, sitting around the nurses station is super mundane. I scrubbed in on as many C sections as possible in order to avoid performing vaginal deliveries. It actually was pretty cool and I got to learn how to suture. Was pretty happy about that. Did a few D&C's too. 

Nights were similar, except at night. Had more vaginal births than C sections during nights.

Gyn surgery was pretty nifty. Got to see a lot of cancerous female parts. Ladies, please get your cervix checked. You don't want to end up swollen, bleeding, and sick because you skipped an "uncomfortable" office procedure. Didn't get yelled at when maneuvering the uterus for the Da Vinci machine, so that's a plus (I heard that the guy who is the DaVinci man tends to yell at people). 

Clinic was probably the worst part. Pregnant females are so... well... [insert adjective here]. You'd think they'd be nice because they're coming to a free clinic. But no such luck.  And there were a LOT of diseased parts. It's sad too, to think the lifestyle into which these children will be born.

These residents with whom I worked were awesome. They were supremely nice and helpful and give me learning tips whenever I had questions. Very nice of them. 

The ob/gyn shelf was pretty hard for me. My worst score out of all of them. I highly recommend doing all the UWorld questions, reading Case Files, and going over the Kaplan videos. It's divided fairly evenly between ob stuff and gyn stuff. I remember having at least 3 fetal heart and contraction tracings, questions about pre-eclampsia management, stages of labor, and OCPs. Then there were at least 4-5 vaginal discharge questions, a few dysmenorrhea q's, a couple of PCOS q's, and various cancers of the angry vag/ute. Have fun. 

So anyway, I'm on ICU now. Having a good time so far, this is much more my style. Lots to read. Peace out kids.

Mood: Chill
Music: Michele McLaughlin -  The Druid's Prayer

On Surgery (and other things)

Greetings one and all! So I am in a little town in BF-nowhere, NC aka Morganton NC. Actually, I'm residing near Valdese NC and working in Morganton. Valdese is a tiny little village that I completely missed the first time I drove through because I thought the downtown was just a neighborhood. The population is something like 1400. Pretty dinky. I don't mind that except there is literally NOTHING to do out here. Everything is closed on Sundays for some reason. Places have very odd hours of operation. I went to Hickory, which is a tiny town about 20 min away and honestly, the place looks so run down that I wouldn't be surprised if it became a ghost town within the next 10 years. A lovely place to spend my birthday, which was Aug 29 for all those who care. And btw, thanks to all who wished me  a happy birthday! It was pretty nice actually. And coming back to all the messages and wall posts really brightened my day.

Anyway, I wanted to talk about surgery. My surgery experiences took place up in Buffalo NY at Sisters Hospital. It was a lot of fun. LECOM requires 8 weeks of it but since the last rotation block is cut 1 week short, I only had 7 weeks. My first 2 weeks was general surgery at St. Joseph's, which is right near Sisters. They're all affiliated. It was pretty interesting. An eye opening experience for sure. You go in around 7am and round on some patients prior to doing the surgeries. They let you scrub in on basically any surgery you want, as long as you keep busy. I mostly did lap choles, open abd surgeries, some abscess drainages, and bowel resections. They let me do some suturing but I didn't get to cut stuff. Boo. My next 2 weeks were vascular surgery at Sisters. That was pretty awesome. I assisted with carotid endarterectomies, fem-pop bypasses, varicose vein removals, AAAs, etc. There are a few vascular surgeons and they are all great teachers. Very willing to explain things and if you ask to do stuff, they are more than happy to let you do things. That was a good 2 weeks for me. I then did a week with a plastic surgeon at Sisters. Mostly breast cancer patients who needed breast reconstructions. He also had outpatient surgeries such as cyst removals, nipple tattooing, and other minor surgeries. He is one of the best plastic surgeons in the area and a great teacher as well. My last 2 weeks were with a cardiothoracic surgeon and that was probably the best time of 3rd year I've ever had. He basically let me do half of the surgeries we performed, as in let me cut stuff, suture things, close, place chest tubes, pericardial windows, etc. That was amazing. 

My ambition upon entering med school was to be either a neurosurgeon or a cardiothoracic surgeon. However, I think my personality fits IM better. I also could never do 5 years of general surgery. Absolutely not my thing.

I'll comment on the surgery shelf too. It's an IM exam. You have to know a lot of pre-op and post-op stuff, which in real life, IM docs manage those a lot. I would do UWorld questions, abdominal IM questions, and know pre/post op management and complications really well. Especially post-op fever.

So yeah, I'm currently doing IM in this tiny little town so I'll probably have a bit more time to update this in the near future. Can't wait to go back home. Happy labor day! Celebrate work by playing all day! :)

On Pediatrics

A most wondrous Monday morning to you all. I hope your weekend was relaxing. I hope you had fun. I hope you had something delicious to eat/drink at least twice. Ok whatever....


I'm in somewhat of a foul mood... not sure why. It may have something to do with waking up at 5am. I forgot to change my alarm for this morning (I don't have to be in the hospital til 8:30am) and was rudely awakened. Anyway, I just had my Honey Bunches of Oats (tropical flavors :D) and I'm ok now. I might have to pop a starbucks double shot energy though.... and I really want applewood smoked bacon right now... mmmmmm.....

So I'm gonna write a small spiel about pediatrics. Let me start by saying I love kids. They are hilarious and the funnest little buggers ever. They whine and cry and puke and pee yet if you know how to turn on their brains, they are the best learners out there. They pick up on things you don't even realize. Anyway, I did my peds rotation through Sisters Hospital in NY. It's an outpatient clinic so no cool hospitalizations for me. But the hours aren't bad: essentially 8am-5pm every day on average. I think my Mondays were longer and I had Thursdays off. Which was awesome. The doc was super chill, very old school pediatrician. We saw kids from 2 days old to 22 year olds. He would have you observe the H&P the first week, then after that you do everything, including writing the note. He would watch in the room but essentially let you do it all. Come to the physical, he might listen to the heart and lungs, but again, you do it all. Which I think is the best way to learn. I had a lot of fun on this rotation. We kept busy most of the time but sometimes you get cancellations and you have like a 45 min block of downtime. I used those opportunities to study for the shelf exam. We didn't see anything super crazy. Your typical viral URI's, viral gastroenteritis (we put a lot of people on the BRAT diet), otitis media, scabies, head lice, mono, vaccines, warts, strep throat, and standard checkups/sports physicals. Not bad.

I was surprised I didn't get sick at all during the rotation. I got sick during Ob/gyn though... ugh that's a whole different experience that I don't know if I'll be posting about because my choice of words may cause this blog to become R rated.... anyway, Peds... when kids get sick, treat the parents because a lot of times, kids are sick because they are stressed. Parents: don't stress out your kids to the point where they get sick. Or you may deserve a hearty flogging.

On Psychiatry

A most invigorating and marvelous morning to all. Actually, it's kinda crappy right now. AC broke yesterday and it's pretty close to 80°F inside. Not appreciating that. Especially since I have to wait until Monday to get it fixed. Ugh. There is no curse in Entish, Elvish, or the tongues of Men bad enough for such treachery.

Those who know me personally know my thoughts on psychiatry. But I am not here to parlay semantics or opinions on the matter. My time in psychiatry was brief, albeit somewhat interesting. I was at Manatee Glens in Bradenton. I found the hours there promising (maybe 10am-1 or 2pm) and I did not have to do much. Ideal. We interviewed new consults in the morning, waited for the attending to show up (chatting with the case manager in the meantime), and did lightning-style rounds with him. And that was pretty much it. No weekends. I was there with some of my classmates, which made being in a nuthouse slightly more tolerable. I did see some pretty cool cases. Disorganized schizo, paranoid schizo, manic depressives, bipolars, depression, etc... I felt bad for these people. Not because much of it was their own doing in poor choices, but because of their utter hopelessness and despair that no medication or counsel can repent. It was profound to see these beings in their state. 

Speaking of psych, is anyone else as sick of hearing about the Zimmerman case as I am? Seriously, whenever something happens that makes the public media, everyone suddenly becomes an expert in the topic and thinks their opinions are law. It's sad, really. Here's a synopsis of the case:
1. We don't know what really happened.
2. People think they know what really happened.
3. Even if people don't know what happened, they convince themselves that certain justices should be taken.
4. #3 is based on pure emotion and bias.
5. People are now flipping out because their opinion on the outcome of the case is not to their liking.
6. People forget that they were not present at the crime scene or the court.
7. Stuff like this happens all the time. Climb out of your baby crib and welcome to the real world.

Anyway, I'm hungry. Enough about psychiatry, petty politics, and social media. Time to make breakfast. Boom.

On Internal Medicine

Well, a very happy morning to all. I feel pretty great this morning. Woke up at 10am, got some Tropical Honey Bunches of Oats, and now here we are. What's going through my mind right now? How I'm actually in my 4th year of medical school. And how I actually have a weekend off after my first week of audition rotations. Amazing. When I heard about this daunting concept of basically auditioning for a residency, I had no idea what to expect? Do they work you like a resident? Do they expect you to know as much as a resident? Are they going to pimp you incessantly? Do you have to work all weekends and holidays?

Nope. At least, not in this rotation. I actually went and asked the senior fellow (I'm on cardiology at Largo Medical Center) if they wanted any help over the weekend and he said "Dude, let the residents suffer. Go enjoy yourself this weekend." Fine by me haha. I'm really digging this team. The residents, fellows, and attending are really chill and very happy to teach. It's amazing how good coworkers can bring any experience up a few notches.

Anyway, I feel like talking about Internal Medicine. Specifically, my experiences when on the IM service. I did IM mainly at 3 locations: United Memorial Medical Center in Batavia, Sisters of Charity in Buffalo, and Mercy South Buffalo. UMMC is a small hospital and the internists are part of the hospitalist service. So they basically do shifts (7-7). That's pretty cool since you don't have to deal with anything when you're off shift. This was actually one of my favorite rotations because there are no IM residents. You work one on one with the attending and they let you do a lot. They enjoy teaching and are happy to answer whatever questions you might have. It's a small hospital so everyone works in a fairly tight-knit group. Everyone knows one another and people are very friendly. There are PAs who work with the hospitalists and they are so chill. 

SOCH and Mercy are a little different. The hospitals themselves are much larger and there are many more employees. It's not uncommon to find yourself lost in some random hallway you've never been to even after a couple weeks in. There is a residency program at SOCH (both hospitals basically run under SOCH and you apply to residency through SOCH, but you might rotate and do a month or however long at Mercy) and having done rotations there, I must admit the IM program is very good and enticed me for a while. They have regular didactics  and meetings, which are rather annoying, but the actual service is awesome. You have a lot on your plate, with residents taking up to 10 patients each, but it's good training and I feel like many New England residencies are pretty hardcore like that. I think that explains a lot... anyway, I'll describe a typical day in SOCH or Mercy:

We usually arrive around 6am to round on patients. As a student, they let you take up to 3 patients, but I've taken 4 or 5 a number of occasions, especially if you end up with a bunch of boring patients (like asthma exacerbations or cellulitis). I like keeping busy because my brain starts meandering with boring things. So you check up on your peeps and write up the note, then go over your patients with the corresponding resident to make sure your note is hunky dory, then sometimes there is a meeting called morning report, which usually is some sort of case presentation by a resident and/or a lecture on a specific topic by a resident, attending, or student. I'm not a person who gets much out of being talked to or lectured so to me, it's kind of a waste of time. Not to mention a lot of times, morning report is at 7am and come on, who is really going to pay attention when your coffee hasn't even kicked in yet? I digress. If there's no morning report, you do your thing until the attending comes around and starts rounding. Some attendings are great and do table rounds and only do bedside rounds on new patients or if a patient has something interesting to show to the team. Other attendings want to to bedside for every pt on the list and that can sometimes take forever. But, overall, you get a lot of pt interaction and experience taking H&P's. After a while it gets old though. If you ask, you might get the opportunity to do admissions with the residents or attendings in the ER and that's always more fun. I like doing admissions because you actually have to do a full H&P and come up with the diagnosis and plan. Early on in 3rd year, that was difficult because you obviously don't know enough about pt management to come up with a good plan, but you talk to the docs and learn about how to manage pts and soon you get the hang of it. I think probably 2 weeks into my very first rotation (which was UMMC), the attending felt comfortable sending me to the ER to do admissions on my own and discussing the plan with me after I'm done.

You always hear about the deathly hours associated with IM. I feel like most of the time, it's worth it. As an internist (this goes for FP to), you're a jack of all trades. You see the majority of the inpatients. You have to be comfortable in dealing with and treating all kinds of patients, from the young to the old, from a simple cellulitis to a train wreck in the ICU. You're going to deal with malingering drug seekers, psychotic bitches who have unrealistic expectations about everything, fibromyalgia pts who can't ever get comfortable and who freak the nurses out because they have "pain". So the more you deal with this type of thing, the easier it becomes.

I'm choosing to go the IM route because IM is not organ/system specific. You need to know all of it. The body is a unit. The body heals itself (if you give it the right conditions). And as a physician, your job is to entertain the patient and give them the right conditions so they can heal themselves.

On Family Practice

So I have just finished doing some grocery shopping at Sam's Club so I don't have to shop for the next 2 weeks. Except for milk... I haven't enough room in the fridge to hold another gallon of milk so that's something I have to buy regularly. A stocked fridge is a happy fridge. So now that I have everything under control and the water getting to a boil, I'll take a minute to talk a little bit about my last rotation: Family Practice. In fact, I'm going to post a blog about every single one of my rotations. Just because I want to. And because I know some of you out there do read my blog :)

So I did my FP rotation at Sisters Hospital in Buffalo, NY. Four weeks of... well... learning. Yes, I think that's the most appropriate term at this point. The entire team is filled with nice people. I have never before met attendings and residents who seemed so chill... well, most of them anyway. But indeed, it was filled with niceness almost to the point where you see rainbows and balloons coming out of each of their heads. My day would start depending on what time the attending feels like rounding in the hospital. If they want to start at 8am, I woke up before 5am (keep in mind it would take me an hour to wake up, get dressed, have breakfast, etc), plus an hour drive, then another hour to see my patient and write the note). If the attending started at 10am, I would wake up at 7am, which is much more reasonable in my opinion... but anyway...

I would go to the floor and look up my patient. Check the labs, data, etc, then see the patient, write up my plan, and wait for the attending to show up. Pretty routine. Sometimes they gave me 2 people to see and I would allot myself another 10 minutes or so, but usually it was just one. I had a good selection of run of the mill cases and a couple of more intense, cool cases. COPD exacerbation, HCAP in an elderly, CAP, pancreatitis... But I had a Steven-Johnson Syndrome case... felt bad for her, she was such a sweet lady going through so much. The hospital rounds varied greatly with time. Some attendings finished rounds with 6 patients in an hour, others would take 3 hours just to see 3. Whatever the case, the afternoons = go to jail. Do not pass go. Do not collect $200. Go to clinic.

Clinic = doctor's office. Starts at 1pm. Where you either watch and be bored to tears, or you do history and physicals (ie yearlies, checkups, whatever you wanna call them) ad nauseum, or sit around and be bored. Or if you have reading material, don't forget that! Clinic ends at 5pm or 9pm, unless your resident or attending lets you leave early.

Or if it's your afternoon off, that's always a good thing. Thursday afternoon are either really awesome or really crappy, depending on how you think of it. All must be present for the DO day lectures/presentations on Thursday afternoons. That buys you a get out of clinic free card, but you're stuck in the hospital lectures on stupid things for the afternoon. Sometimes, they have free food from a drug rep or something. I'm agreeable to that.

Every week your senior resident or attending will probably ask you to present on a topic (not for DO day, this is typical when they ask you something and you don't know the answer and they tell you to look up the topic). Pretty short, 5 minute thing about some sort of disease. Probably a quick summary of clinical presentation, symptoms, diagnosis, labs, and treatment/management would be plenty. The good thing about these is that it forces you to relearn the basics about the disease process that you may have forgotten since step 1, and also that you put together the whole picture and tie it in to treatment with a real life case. I actually don't mind when they have me look up case topics.

So yeah, Sisters' FP residency program is supposed to be one of the better ones around here. So if you're looking into it, I suggest getting a rotation here if you enjoy the upstate NY area. I'd rather do Internal Medicine, so my interest lies elsewhere.

Oh, and my pasta was really good. Quinoa pasta toss with olive oil with spicy garlic alfredo and broccoli. Check it out:

3rd year pains

So this is the end of 3rd year. A couple months, then comes Step 2 of the boards, then another year of rotations, with some interviews and other bullshit thrown in the mix. As if we haven't had enough bullshit already. 

This year has been pretty interesting with its fair share of ups and downs. I have to say that the only rotations I actually enjoyed were Internal Medicine, Urgent Care, and Infectious Disease. I love kids but I hate dealing with parents so no pediatrics. I want absolutely nothing to do with ob/gyn and the birthing process is disgusting, plus pregnant females are such a pain to deal with. Family practice is ridiculously boring and I don't like the office/clinic setting. I'm starting surgery in a week and although it might be interesting, I hate standing for any extended duration of time and I don't plan on going into surgery... so essentially I've ruled out a good number of specialties... I'm really digging infectious disease, although cardiology can still be a possibility.

I start surgery next Monday (ugh) but amongst all this chaos, LECOM has been absolutely horrendous at even attempting to help me set up 4th year rotations. Am I surprised? No. They have all of 2 or 3 people managing an entire school's rotations. Not ideal. Thus, I've decided that they're going to be zero help and I'm setting up my schedule and my rotations on my own. Whatever.

Board studying is pretty stagnant at this point. I'm trying to fit in study time whenever there's down time in the hospital but those are few and far in between. Problem is that Sisters of Charity Hospital works the crap out of you and by the time you're home, showered up, and prepared to study, it's dinner time and then you only have a couple hours at best to read. Not ideal.

Shelf exams... I don't even know where to start. I think Case Files does a pretty decent job at giving you the essentials... but like any board exam, I don't think any amount of studying will prep you sufficiently. The questions are unpredictable and stuffed with bullshit to sift through. Then, the questions are long paragraphs so that detracts from the reading time. Plus, they don't let you eat while taking the shelf, so you're hungry and pissed off and tired the whole time. And they wonder why people do so bad. But anyway, if you're studying for shelf exams, you need these things: Case Files, UWorld, and Toronto Notes for Family Medicine. As far as the ob/gyn shelf, well, you'll either love it or hate it, but either way, it's going to rape you.

I'm so over this student thing. Ready to be an attending physician already. Or at least throw me into some IM residency and let me do my thing.

Planet Earth!

I love this series. The video captures are absolutely stunning. I don't know why I didn't watch it sooner. I've had it for over a year now and only just started watching the series. Majestic, touching, and most of all, relaxing.

One thing I will mention is that I was watching this at around 1:30am last night and fell asleep while doing so... and I still wake up at 9:30am :( Med school is preventing  me from being able to sleep in.

Current mood: chill
Current music: Mozart's 25th Symphony

Middle of 3rd Year Optimism

Why hello there one and all.

So 3rd year of medical school is going and going... it's flying by yet seems to linger on like a mildly distasteful beer. I am currently on an Infectious Disease rotation (aka ID) and it's pretty awesome. Certainly a change from the last couple months where OB/GYN and pediatrics made me want to shoot myself in the face multiple times. Needless to say, I've already eliminated those two specialties from my future. However, ID seems very promising. I enjoy it because the consults are fairly fast paced yet interesting. It's almost like a break from Internal Medicine because you can more or less ignore a lot of the bs that interns deal with and just focus on the reason for the consult. However, as an ID specialist, you can also act as the attending physician for certain patients and manage them as a whole. Sure, you can do something similar as a cardiologist or any other specialty really... but there is something about dealing with microbes that is utterly fascinating to me. Such small things can bring down the largest beast or smartest human. It's constantly a race between us and the bugs. 

3rd year is formidable yet awesome at the same time. You win sometimes but you lose a lot. Sometimes you're brilliant and bring back a pulse from asystole, but sometimes you put the blood pressure cuff on inside out and the attending has to correct you in front of the patient. It makes the rotations go by very quickly. By the end of each shift you're likely to be dead tired and hungry, but on days where you're in the office and the drug reps bring food, you leave happy. 

Regardless, I am quite pleased with how life is going in general so far. Everyone has been so supportive of me and keeping me entertained. Word. My beer cellar has reached a fairly impressive number. I learned some new things on the guitar. I'm able to keep a beat when playing drums for longer than before. My friends have matched with their desired residencies. Woot. So there you have it.